Which is a common early symptom of Friedrich's ataxia?

• A. Severe seizures
• B. Early gait unsteadiness progressing to upper extremity ataxia
• C. Hearing impairment
• D. Blindness

Answer: (B)

Friedreich ataxia begins with a problem in the coordination of movement that shows up early as gait unsteadiness. This happens because the disease damages pathways that carry proprioceptive and cerebellar information to control walking. As the condition progresses, that same degenerative process also affects the arms, so coordinating movements in the upper limbs becomes impaired. So the typical early pattern is a walking unsteadiness that later evolves into problems with the arms.

Seizures are not a defining early feature of Friedreich ataxia, and hearing impairment or blindness are not common early signs. They can occur in some individuals later on, but they do not characterize the initial presentation.